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Table 2 Pharmacokinetic studies of epinephrine autoinjectors. Comparison of injection in the middle part of the antero-lateral (m a-l) or distal-ventral (d-v) area of the thigh

From: The pharmacokinetics of epinephrine/adrenaline autoinjectors

Subject\Study Simons et al. Edwards et al. 2013 [10] Duvauchelle et al. 2018 [11] Worms et al. [12] Turner et al. [13]
1998 [8] 2001 [9]    Low STMD Middle STMD High STMD  
Brand Epipen® Epipen® Epipen® Auvi-Q® Anapen® Anapen® Anapen® Epipen® Epipen® Epipen® Emerade® Emerade®
Needle length, mmj 10.5 15 15 15 10.5 10.5 10.5 13–18 (20) 13–18 (20) 13–18 (20) 23 23
Number of pat. 8 13 135 67 18 12 18 12 12 11 12 12
Gender Children Male, adults Male, adults Male, adults Male, adults Female, adults Male, adults M = 6; F = 6 M = 6; F = 6 M = 5; F = 6 Adolescent
M = 7; F = 5
Adolescent
M = 7; F = 5
Weight kg ?
15–40
85 ± 5; 62–114 77.0 ± 11.5 77.0 ± 11.5 75 ± 10.5 78 ± 7.9 75 ± 10.5 M/F 103.5/63.6 M/F 107.7/83.3 M/F 122.4/85.0 61
41.8–76.4
61
41.8-76.4
BMI kg/m2 36.6 ± 4.6; 29–64 25.4 ± 2.7 25.4 ± 2.7 23.3 ± 1.9; 18–26 29.7 ± 1.9; 26–34 23.3 ± 1.9; 18–26 M/F 32.4/21.3 M/F 32.2/28.1 M/F 36./31.4
Age years 4–12 18–35 33.2 ± 6.3 33.2 ± 6.3 31.5 ± 9.2 33.3 ± 9.1 31.5 ± 9.2 M/F 36.2/46.0 M/F 34.5/38.8 M/F 32.8/39.0 15.4 15.4
Site ? Thigh, m a-l Thigh, m a-l Thigh, m a-l Thigh, m a-l Thigh, d-v Thigh, m a-l Thigh, m a-l Thigh, m a-l Thigh, m a-l Thigh m a-l Thigh m a-l
Rote i.m.a i.m.a i.m.a i.m.a i.m. i.m.a i i.m. i.m.a i.m.a i.m.a i.m. i.m.
Dose mg 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.5
Plasma level analyzes hours 3 3 6 6 6 6 6 6 6 6 3 3
Tmax 1, minutes 8 ± 2c
5
10f 5–10g; 5i 5–10g; 5i 12 ± 7; 5d 14 ± 6; 15d 13 ± 7; 5d 9 (3–60) 10,5 (2–39) 30 (9–120)
Tmax 2, minutes ≈ 20e ≈ 40f 25–308) 25–30h ≈ 50d ≈ 30d ≈ 50d
Cmax1 pg/ml 2136 ± 351 12,222 ± 3829 520 486 377. ± 298
275d
440 ± 416
≈ 250d
353.9 ± 283
≈260d
M/F
400/640
M/F
480/520
M/F
420/630
Cmax2 pg/ml 1000f ≈ 6000f ≈ 300h ≈ 330h ≈ 250d ≈ 275d ≈290d
No of Cmax 1? 2 2 2 2 2? 2 2 2 2 2 2
AUC0-20 h*pg/mk 69.3 ± 54 55.9 ± 45 68.4 ± 50    
AUC0-t h*pg/ml 466 536 M/F 273/288 M/F 281/209 M/F
263/311
AUCinf h*pg/ml 108,000 ± 18,000 583 724 459.2 ± 129 677.7 ± 161 473.1 ± 139
  1. aIntended localization of the bolus; cIn the s.c. group, 2/9 children and in the i.m. group, 6/8 children showed a Tmax at 5 min. [8]; d Estimated from Figure 3 in [11]; e Estimated from Figure 1 in [8]. f According to Figure 1 in [9]; g Approximately according to Table 3 in [10]; h According to Figure 2 in [10]; i s.c. in 10/12 women, i.m in 2/12 women as localized by ultrasound [10]. j The variation 5 mm for Epipen®, not known for Anapen® [11, 27]; k Worm [12]: AUC registered for 6, 15 and 30 min, but data not reported